Metastatic neoplasm to the kidney. A report of four cases studied with angiography and nephrotomography.

Abstract

Metastatic neoplasm to the kidney is not uncommon, but it is unusual for a metastasis to the kidney to present as a solitary renal mass lesion or to cause urinary tract symptoms. We have had the opportunity to radiographically study four such lesions with angiography and nephrotomography. In all instances the angiogram revealed an avascular or hypo-vascular lesion while nephrotomography (performed in three cases) clearly indicated that the lesion was not a simple benign cyst. The presentation of the clinical and radiographic features of these cases forms the basis of this report. Case I: A 59-year-old male was admitted to the Boston University Hospital complaining of shortness of breath of two to three months duration. He also complained of a nonproductive cough and a gradual weight loss of thirty pounds during this period. He had been smoking three packs of cigarets a day for forty-six years. Positive findings on physical examination included a left supraclavicular node and mild clubbing of the fingers. The admission chest radiograph showed a lobulated mass in the left hilar region. A scalene node biopsy as well as bronchoscopy revealed epidermoid carcinoma. A course of radiotherapy, cobalt 60, to the mediastinum and left chest was administered. The patient was discharged from the hospital and then was readmitted for a second time seven months later with a chief complaint of right hip pain. No definite lytic or blastic lesions could be identified on x-ray examination of the hip, and further work-up to evaluate possible metastatic disease to the retroperitoneal and epidural areas was instituted. Myelography revealed lumbar epidural metastases. Intravenous pyelography and inferior venacavography demonstrated retroperitoneal masses. A large intrarenal mass was also noted at the lower pole of the left kidney (Fig. 1, A). The left renal mass was evaluated by renal arteriography and nephrotomography. The lesion revealed no “tumor vessels” but demonstrated amputation and encasement of intrarenal arterial branches (Figs. 1, B and C). Nephrotomography confirmed the fact that the lesion was not a simple benign process (Fig. 1, D). A left renal exploration was decided upon so that the subsequent treatment could be planned on the basis of the histology of the kidney lesion. A left nephrectomy disclosed an 8-cm-in-diameter metastatic lesion (epidermoid carcinoma) to the kidney with the identical cell type as seen in the left supraclavicular node and bronchoscopic biopsy previously obtained (Fig. 1, E). Metastatic disease to the peritoneum, left para-aortic nodes, and muscular fascia was also present. The patient was given palliative radiotherapy to these areas. Case II: This 61-year-old male was admitted to the Boston University Hospital for the surgical removal of a mass in the soft tissues of the lower left leg. The mass was 15 × 5 × 5 cm and was firm but not attached to adjacent bone.